Loading...
1993, 07-09 Permit App: 93005622 Mechanical Fixtures• 146011.1576/06 Ada MECHANICAL PERMIT APPLICATION FORM In o;mation Worksheet JOB STREET ADD- SS: CITY/STAT ZIP• �� .. CIC OWNER: f /i ,9 L q3 . S1 21- MAILING z MAILING ADDRESS: PARCEL NUMBER: PHONE NUMBER: % - L `i ? g � (Street) ' CONTRACTOR: 11). ice. / - CtAk ( MAILING ADDRESS: - J3 2/9 (Street) DESCRIPTION (City/State) (Zip) LICENSE NUMBER: IUG> k774949,1/0.: QL J 0 PHONE NUMBER: 9cRd - "kg 9 (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) :1NOO.QSTOIf E/INSERT GAS WATER HEATER S AS>P I,I P ENT 100,000,:STU .(INGLU.Q. GAS EQUIPMENT +100,000 BTU DUCTWORK) :.GAS..:P.IA.I ...G:-. EA:QtlA...... BOILER/REFRIG 1-100M BTU AQIhER1.R. 0M°:BTU;;:«:>:<:> BOILER/REFRIG 501-1,000M BTU BOILER/REFRIG +1,750M BTU kiFAT>PU ?{<J 11 a dt :WA TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS kl:iiiNSIOAAKONOMONER°1;Q.;TONS HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP B► AIR; CO DITLONER. + VENTILATING FANS TYPE I HOOD (PER 1 �Sf:`.?:�.: �w ;ter: kr.•.�. CLOTHES DRYER GAS LOG tSC.PEi EONS (NQT COVERED ELSEWHEI UNLISTED GAS APPLIANCE <400,000 BTU SLI.NTECCPPIANC?40000 S' USED APPLIANCE <400,000 BTU :::.:.:.:::.:..... AIR HANDLER <10,54141CFM NOTE MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x 10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x1.00= x 12.00 = x 20.00 = x 25.00 = x35.00 = x 60.00 = x12.00 = x20.00 = x 25.00 = x 35.00 - x 60.00 = x 10.00 = x 10.00 = x 50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x50.00 = x100.00 - x 12.00 = x 15.00 = /D • e -O / 4,2. 6,-61 c� � - Q O SUBTOTAL $ , Ato-D PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE =$ V,DO 0. 111- 4L,AL Spokane County Division of Buildings Wnef 1 QA' Rreintlu.nv Aute n.., C.,.,L.. r,,, %A/A nn")en lrnlll Arc Oc7G